Recurrent herpes in pregnancy: What are the risks for vaginal birth?

I have had herpes for 10 years, with five outbreaks in the 13 weeks of this pregnancy. You said that a woman having an outbreak while in labor our delivering should have a cesarean and not attempt a vaginal birth. What are the statistics for babies contracting herpes in vaginal birth during outbreaks? I want to avoid a cesarean at all cost but, want to know the real risks in percentages. Is there something that I can do to stop all of these outbreaks. I have most outbreaks after being short on sleep.


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Adverse pregnancy outcomes are more likely when the initial outbreak of genital herpes is during pregnancy, because with the first episode, there are usually no maternal antibodies for the baby.

"Williams Obstetrics" (1997) states that the presence, absence or frequency of recurrences does not predict asymptomatic shedding at delivery. Such shedding appears to be an entirely random event of short duration, usually less that seven days. There is more than a 95 percent chance of a negative culture seven days after an episode of asymptomatic shedding during pregnancy.

We no longer recommend weekly cultures to detect asymptomatic shedding, and cultures taken during labor are rarely positive. It is known that genital cultures for herpes are not predictive of the risk for neonatal infection.

The following approach is now used by most services (American College of Obstetricians and Gynecologists):

  1. Cultures are taken to confirm the diagnosis when a pregnant woman has lesions. If there are no visible lesions at the onset of labor, then vaginal delivery is acceptable
  2. Weekly surveillance cultures of women with a history of herpes but without lesions are not necessary and vaginal delivery is acceptable.
  3. Cesarean delivery is performed if primary or recurrent lesions are visualized near the time of labor or when the membranes are ruptured or if there are prodomal symptoms of a recurrence.

Nearly half of all those newborns infected with herpes virus are preterm. Primary herpes causes infection in infants about 50 percent of the time and only four to five percent of the time with recurrent disease. Another study showed no infants infected with exposure to recurrent disease.

This data might lead us to believe that even if a mother has evidence of a lesion or who is suspicious of asymptomatic shedding might attempt a vaginal delivery. But I don't know any care provider who would recommend a vaginal birth under these circumstances.

I wish you the best making this decision. It is not uncommon for herpes infection to decline in the later weeks of pregnancy, so I hope you won't have to worry.

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